RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200586 SEPARATION DATE: 20060711 BOARD DATE: 20130220 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B, Infantryman) medically separated for chronic neck pain. He was treated, but did not improve adequately to fully perform his military duties or meet physical fitness standards. He was issued a permanent profile and underwent a Medical Evaluation Board (MEB). The MEB found his neck condition medically unacceptable IAW AR 40-501, and referred him to a Physical Evaluation Board (PEB). Six other conditions (lumbago, ulnar tunnel syndrome, right shoulder pain, right knee pain, hypertension, and history of staphylococcal skin infection) were all listed on DA Form 3947 as medically acceptable. The PEB found the CI unfit for military service due to chronic neck pain, and rated the condition 0%. The other six conditions were all found to be “not unfitting, and therefore not rated.” The CI accepted the PEB findings, and was medically separated with a 0% disability. CI’s CONTENTION: “Chronic pain that has persisted in neck since time of injury. Diminished ability to work with anything at or above head level, due to sharp intense pain.” SCOPE OF REVIEW: The Board’s scope of review as defined in DoDI 6040.44 is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The unfitting neck condition (chronic neck pain, C5-C6 with mild central spinal stenosis and encroachment of right foraminal opening) meets the criteria prescribed in DoDI 6040.44, and is accordingly addressed below. No other conditions are within the Board’s purview. Any condition outside the Board’s defined scope of review may be eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Army PEB – Dated 20060525 VA (2 mos. Pre -Separation) – All Effective 20060712 Condition Code Rating Condition Code Rating Exam Chronic Neck Pain 5243 0% Cervical Stenosis & Disc Disease 5242** 0%** 20060428 Lumbago Not Unfitting Thoracolumbar Spine Condition 5237* (Deferred)* 20060428 Ulnar Tunnel Syndrome Not Unfitting Left Cubital Tunnel Syndrome 8599-8515 NSC 20060428 Right Shoulder Pain Not Unfitting Right Shoulder Condition 5201 NSC 20060428 Chronic Right Knee Pain Not Unfitting Right Knee Condition 5260 NSC 20060428 Hypertension Not Unfitting Hypertension 7101 10% 20060428 History of Skin Infection Not Unfitting Residual Scar, Left Flank Area 7804 0% 20060428 .No Additional MEB/PEB Entries. 20060428 Combined: 0% Combined: 10% *Thoracolumbar spine condition (5237) was rated 10% by a subsequent VA Rating Decision (VARD) dated 20071123 ** VA rating for cervical spine (5242) was later increased to 10% by a subsequent VARD dated 20080815 ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed by the CI regarding the impairment with which his condition continues to burden him, and the significant impact it has had on his quality of life. It is noted for the record that the Board is subject to the same laws for Service disability entitlements as those under which the Disability Evaluation System (DES) operates. The DES has neither the role nor the authority to compensate members for future severity or potential complications of conditions. That role and authority is granted to the Department of Veterans Affairs (DVA). The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation. While the DES considers all of the CI's medical conditions, compensation can only be offered for those conditions that cut short a member’s career, and then only to the degree of severity present at the time of separation. The DVA, however, is empowered to compensate for service-connected conditions and to periodically re- evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment change over time. Chronic neck pain. The CI injured his neck in July 2005. Magnetic resonance imaging showed some abnormalities at multiple levels of the cervical spine. It was decided that he was not a surgical candidate. Several non-operative treatment strategies were tried. In spite of treatment, his neck pain persisted and an MEB was initiated. On 28 April 2006, the CI had a VA Compensation and Pension exam at VA Medical Center in Nashville. He reported that his neck pain was precipitated by exercise, prolonged standing, and prolonged sitting. On examination, the neck was normal in appearance and there was no tenderness to palpation. Muscle spasm was absent and muscle strength was normal. Range-of-motion (ROM) was measured and is summarized in the chart below. Eighteen days later, his MEB narrative summary was dictated on 16 May 2006. Cervical ROM was measured by physical therapy on 18 May 2006, and is summarized in the chart below. Cervical ROM MEB-PT ~2 Mo. Pre-Sep (20060518) VA C&P ~2 ½ Mo. Pre-Sep (20060428) Flexion (45° is normal) 55° 45° Combined (340° is normal) 285° 335° Comment Pain with motion No mention of painful motion §4.71a Rating 10% 10% The Board carefully examined all of the evidentiary information available. IAW VASRD §4.71a, a rating of 10% is appropriate when combined ROM of the cervical spine is greater than 170 degrees, but not greater than 335 degrees. Therefore, both of the ROM exams meet VASRD criteria for a 10% rating. There was no evidence of ratable peripheral nerve impairment in this case. CI had normal muscle strength and no objective evidence of neurological deficit. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 10% for the chronic neck pain condition. It is appropriately coded 5238 and IAW VASRD §4.71a, meets criteria for the 10% rating level. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the chronic neck pain condition, the Board unanimously recommends a disability rating of 10%, coded 5238 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Chronic neck pain, with mild central spinal stenosis 5238 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120605, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130005371 (PD201200586) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)